SCURVY (scorbutus; a synonym a scurvy) — avitaminosis With in a stage of the developed clinical manifestations in the form of widespread hemorrhages, an ulitis, structural change of bones and sheaves, quite often anemias, and also dysfunctions of various bodies. At complete cessation of intake of redoxon in an organism of C. develops approximately in 4 — 12 weeks; at a hypovitaminosis About a wedge, manifestations are less expressed and appear in later terms — usually in 4 — 6 months after developing of a vitamin deficiency.
The scurvy is known since ancient times. Hippocrates described C. as «ileos bloody», having allocated its characteristic symptoms: «from a mouth badly smells, gingivas separate from teeth, from nostrils blood flows, ulcers standing, skin color becomes granite». In the Middle Ages more detailed descriptions of C appeared., observed in troops of crusaders, at residents of the cities and fortresses which underwent a siege. In 15 — 19 centuries high incidence of C. it was observed in countries of Northern Europe during the periods of hunger, especially during wars, and also participants of the first long voyages (in the New World, to India), polar expeditions, at colonists have North of Canada. In imperial Russia in a century preceding Great October socialist revolution it was noted apprx. 30 mass flashes of C., many from to-rykh were followed by high mortality of the population in the provinces which were injured from a crop failure. During World War I in the Russian army more than 300 thousand people were ill a scurvy.
Reasons of C. were not established up to 20 century. Because of the epidemic nature of outbreaks of a disease even its infectious nature, but already since the time of Hippocrates in treatment of C was assumed. significance was attached to food by fresh vegetables and fruit. It is known that in 16 century folk remedies of treatment of C. at the population of Siberia included fresh cervine meat, infusions and decoctions from needles and cones of coniferous trees. During a Suvorov era the Russian military physicians managed to establish connection of C with insight inherent in them. with food. It is confirmed «By the rules distributed by order of A. V. Suvorov to medical ranks», in to-rykh it was specified that for fight against C. it is necessary to apply sourcrout, horse-radish, lemons etc. In 1753 J. Land for the first time directly connected emergence of C. with disturbances of food also recommended along with a fresh vegetables and fruit diet to apply lemon juice to its treatment.
In 19 century since N. I. Lunin's works the doctrine about vitamins arose (see), and at the beginning of 20 century to W. W. Pasch of oozes obtained the evidence of communication of emergence of C. with absence in food of some certain factor. This factor, or «antiskor-butny substance», was allocated only in 1922 — 1927 by S. S. Zil-va from lemon juice. In 1928 — 1933 the Hungarian scientist A. Saint-Djyor-dyi with sotr. identified this substance (redoxon) with hexuronic acid, to-ruyu as the specific antiscorbutic factor suggested to call ascorbic acid (see). These works created a scientific basis for experimental studying of avitaminosis With, detection of features of defeat at a scurvy of separate bodies and systems of an organism, a research of a pathogeny of the main manifestations of a scurvy, and also for development of the preventive measures promoting its elimination as a mass disease. In the USSR the last from the known flashes of C. took place in besieged Leningrad in the period of the Great Patriotic War. Since 50th only isolated cases of this disease are registered. Experience of observations and treatment of C. in besieged Leningrad Len-go of a rzdravotdel is generalized in the special order, in Krom the main symptoms of a disease are stated, three degrees of C are allocated. on weight of its manifestations, and also actions for rendering are regulated to lay down. the help depending on the established severity of a disease.
Etiology and pathogeny. The main reason for avitaminosis With — lack of intake of redoxon food owing to starvation or at food products, free of ascorbic to - you. Promote emergence of avitaminosis of disturbance of absorption of food in intestines (at defeats of an intestinal wall, at diarrhea); accelerate development of C. states, at to-rykh the need for redoxon it is raised (pregnancy, a stress, overcooling, hard physical activity, inf. diseases, etc.). At babies of C. can arise at food boiled dairy products, milk canned food and vegetable purees without addition of redoxon.
Though in etiol. relation of C. is manifestation of insufficiency in an organism of redoxon, other types of the vitamin deficiency (see) caused by defective food also participate in its pathogeny. So, the increase in permeability of vessels which is one of origins of hemorrhages at C., connect not only with avitaminosis With, but also with the deficit of bio-flavonoids which is usually accompanying it (see), or the citrin which is contained in the same types of food as redoxon. It is supposed that development of anemia at C. it is accompanied by the accompanying lack of folic acid (see). Most likely, characteristic of C. the symptom of the expressed general weakness is also connected with deficit of several vitamins though it can be manifestation of the adrenal insufficiency caused by absence only ascorbic to - you, necessary for synthesis of steroid hormones. Except the general weakness, to manifestations of hypofunction of bark of adrenal glands at C. belong a xanthopathy, as at an addisonovy disease, and a tendency to arterial hypotension.
The main and specific to C. displays of a disease, such as hemorrhages, ulitis, changes in bones, have the general pathogeny, to-rogo loss of participation ascorbic to - you in processes of formation of structural elements of a mesenchyma is the cornerstone. Formation of collagen (see), the main substance of a cartilage and a bone, so-called fibrillar structures and the agglutinant providing a continuity of an endothelial vystilka of capillaries is as a result broken. Patol. the ioroznost of walls of capillaries is the reason an izlitiya of blood in perikapillyarny spaces. By data A. Ya. Ya roshevsky, coagulability of blood at C. it is not changed. Remain normal a prothrombin time (see), retraction of a blood clot (see Retraction), duration of bleeding (see the Bleeding time), function of thrombocytes (see).
Due to the destruction of collagen, including short bunches of the collagenic fibers providing communication between teeth and alveolar shoots of jaws, teeth are loosened and drop out. In their circle gingivas get characteristic of C. changes: they become friable, bulk up, are stuck out between the remained teeth, easily bleed (see the Ulitis). As a result of braking of a differentiation of mesenchymal cells, including fibroblasts, osteoblasts, fibrilloblasts, communication between an epiphysis and a diaphysis in a rostkovy zone of tubular bones is broken, the bone structure changes that is promoted by hemorrhages in subperiostal space and in marrow. Anchoring strength between a cartilage and a bone, in particular in places of an attachment of edges to a breast is broken.
The pathogeny of anemia is studied not in all aspects yet. According to O. P. Bykova (1944), in marrow of sick C. the large number of unripe erythroblasts at absence in peripheral blood of normoblasts and a gain of number of reticulocytes is found. It indicates the hyporegenerative nature of anemia at C., what can be a consequence of loss ascorbic to - you from participation in a hemopoiesis. In cases when macrocytic anemia is noted, it is possible to assume an essential role in its pathogeny of deficit folic to - you. Important role in development of anemia at C. plays decrease in secretion salt to - you in a stomach, also caused by absence ascorbic to - you. As a result absorption of iron in intestines decreases that serves as premises for development of an iron deficiency state.
Pathological anatomy. Overall pathoanatomical picture C. it is characterized by a combination of symptoms of exhaustion, hemorrhagic diathesis, an ulitis, disturbances of pigmental exchange and peculiar changes of bone system in a look patol. osteogeneses.
Exhaustion is shown by the general weight loss preferential at the expense of a decrease of muscular tissue, but not a fatty tissue and an atrophy of internals.
Skin is dark, slightly shelled, in places it is covered with elements of a scorbutic purpura of different size, to-rye represent the centers of hemorrhagic treatment of a derma and hypodermic cellulose, especially around follicles of hair. The epithelium in these sites exfoliates in the form of dark red bubbles. Skin hemorrhages usually are found on the flexion surfaces of legs, on a trunk, much more rare — on hands, the head and a neck. Hemorrhages are often infected, ulcerated, ulcers badly granulate. Microscopically ground mass of hemorrhages occurs per diapedesim. In skin the deposits of hemosiderin which are located on the course of vessels in elements of histiocytic infiltrate quite often are defined.
Hemorrhages are found at a research practically of all connective tissue structures. They are found in fastion and aponeuroses, in a fatty tissue, in muscles, bones, a synovial membrane and cavities of joints, in connecting fabric on the course of nerves and vessels, and also in intestines where they usually surround with a rim follicles, quite often ulcerated. Less often hemorrhages in an interstitium of lungs (preferential in back departments), in limf, nodes, in an epicardium, in kidneys meet; sometimes find a hemopericardium, a hemothorax. The hemorrhages in muscles more often arising at persons of young age come to light in the sites located closer to sinews or places of an attachment to a bone; they proceed along muscle bundles and infiltrirut connecting fabric. Subperiosteal hemorrhages are localized most often in the field of an epiphysis of tubular bones. Usually they have an appearance of the hemorrhagic treatment extending on connective tissue layers; the hematomas which are moving apart muscles otslaivayushchy a periosteum are less often formed. In some cases find the centers of an inflammation, as a rule, of hemorrhagic character.
The scorbutic ulitis is shown by hypostasis and a loosening of gums. The mucous membrane of gums gains blackish-blue color. The cyanotic, slightly lagging behind teeth edematous edges of gums and gingival nipples eminating between teeth bleed; they are nekrotizirovana and are ulcerated; the epithelium is torn away by layers. Teeth are easily loosened and drop out. Accession of consecutive infection is followed by development of a stomacace and ulitis.
Changes of internals consist in their atrophy and existence patol. the processes arising as Ts. Otmechayetsya's complications an atrophy of a parenchyma in a myocardium, a liver, goitrous gland. Bark of adrenal glands is expanded, edematous; chromaffin reaction of marrow is reduced. Sluggish regenerator processes in red marrow are shown by the general anemia. In the terminal period there are marantic hypostases and dropsy of serous cavities.
Changes of bone system at C. are very characteristic. At children (a children's scurvy, «a rachitic scurvy») the front ends of a bone part of edges, i.e. zones of connection of bone and cartilaginous parts of edges preferential are surprised. In the part of an edge adjoining to a cartilage the number of osteoblasts decreases, the atrophy of bone crossbeams develops and there are their changes. In marrowy cavities and under a periosteum hemorrhages, deposits of fibrin are noted. As a result of these changes in zones of an osteoarticular joint there are thickenings, and in the subsequent — department of a cartilaginous part of an edge from bone. At such damage of several edges, especially bilateral, the breast together with costal cartilages sinks down and becomes mobile. At the same time pressure of keen edges of the front ends of bone parts of edges causes the decubituses of skin which are gate of consecutive infection. At adults the main changes are localized preferential in an epiphysis of tubular bones of extremities. In hard cases of a scurvy the expressed changes are noted also in spongy bones: osteoblasts disappear, bone crossbeams become thinner. Owing to an atrophy and osteoporosis spongy bones become soft and are quite often easily knifed.
At emergence of complications of C. most often damages of intestines in the form of an endoenteritis, follicular and the follicular ulcerative enteritis and colitis sometimes taking a form of diphtheritic colitis at dysentery are found. In nek-ry cases the vein thrombosis and hemorrhagic heart attacks of intestines is observed (see). Often at C. the aggravation of tubercular process, in particular in lungs is noted, to-ry accepts sharply expressed exudative character (see Tuberculosis of a respiratory organs). Exacerbation of tuberculosis and quite often arising at C. complications in the form of sepsis (see), pneumonia (see), gangrenes of a lung (see Lungs, diseases), a heavy coloenteritis most often are a cause of death of patients with a scurvy.
Clinical picture. Weight of manifestations of C. is defined by rates of development of avitaminosis With and its duration. Symptoms of hypovitaminosis With are not specific and poor: the general weakness, fatigue is noted; tendency to traumatization of gums (firm poor, a toothbrush) with their periodic bleeding is possible. At children the loss of appetite, pallor is noted, they become uneasy. Allocate three degrees of C. depending on expressiveness of clinical manifestations.
At C. the first degree fatigue becomes one of the leading symptoms of a disease. The exercise stress leads to the bystry and expressed exhaustion and emergence of pains in muscles; onychalgias during the walking are characteristic. The swelling of gums, pastosity and nek-paradise pallor of the person is objectively noted; on skin of the lower extremities and trunks come to light the small hemorrhages which are localized preferential around bulbs of hair. Moderate anemia is found. Against the background of reception ascorbic to - you manifestations of C. the first degree quickly disappear.
C. the second degree it is characterized by more serious general condition, disability (patients hardly service themselves). The general weight loss is noticeable, up to exhaustion. The ulitis with gangrene of gums, their bleeding is expressed. Skin gains dark color, in places is spotty is pigmented. Extensive hemorrhages in muscles, in hypodermic cellulose, sometimes subperiosteal and intra joint hemorrhages with an arthropathy are noted (see the Hemarthrosis). Because of hemorrhages in muscles of legs and in joints patients feel painful pains, cannot go. At a blood analysis reveal anemia, acceleration of ROE; concentration ascorbic to - you in blood is reduced by
5 — 6 times. In urine find erythrocytes, the gross hematuria is quite often observed (see the Hamaturia).
C. the third degree it is characterized by the critical condition of patients demanding carrying out urgent therapeutic interventions. Exhaustion, a gangrenous ulitis, cankers of skin, massive and widespread hemorrhages in skin, muscles, internals and serous cavities (in a pleura, a pericardium), and also intra joint and subperiostal are noted. The gross hematuria is often observed, massive bleedings from uric ways and hemorrhagic heart attacks of kidneys are possible (see). Anemia is sharply expressed. ROE is accelerated to 50 — 70 mm an hour. Often join inf. damages of lungs, enteritis (see), sepsis (see).
At C. any degree subfebrile condition or even febrile fever, the resulting rassasyvaniye of hemorrhages can be observed. In uncomplicated cases of C. the neutropenia at the normal general maintenance of leukocytes in blood is often noted; the neutrophylic leukocytosis is usually observed at accession inf. complications. Function of heart at uncomplicated C. significantly it is not broken; tachycardia is sometimes noted, it is tended to decrease in the ABP; changes of an ECG correspond to unsharply expressed dystrophic changes in a myocardium. In lungs at C. the first and second extent of changes usually does not come to light; at C. the third degree the hemorrhagic heart attacks of lungs which are usually complicated by pneumonia are sometimes noted; seldom there is a pneumorrhagia. The disorders of function of digestive organs which are shown abdominal pains, ponosa are often observed. For C. decrease in secretory function of a stomach and damage of intestines about a wedge, a picture of the coloenteritis (see Enteritis) proceeding sometimes already as a complication of C is characteristic. (with a canker of intestines, intestinal a shelterotecheniye).
Considerably wedge, manifestations of C. are defined by localization of hemorrhages. Hemorrhages in trunks of peripheral nerves, usually the subshell, and in substance of a brain, and also subarachnoidal hemorrhages with the symptomatology determined by their localization are described (see the Stroke).
At the persons who transferred C. the second and third degree, contractures of extremities and deformation of joints in connection with development of dense connecting fabric on site of the former hemorrhages quite often form. These changes can lead to sharp restriction of function of extremities, is more often than legs.
Current of C. often is complicated by accession inf. diseases, recurrence hron. infectious processes, in particular tuberculosis, to-ry against the background of C. usually gets a rapid current. The fresh hematogenous disseminated forms are quite often observed. Decrease in a host defense and regenerator processes is shown extremely by a failure of healing of wounds and fractures of bones. Current of any acute inf. diseases (pneumonia, acute intestinal infections, quinsy, etc.) against the background of C. often accepts malignant character and causes the majority of lethal outcomes.
At children of chest age along with hemorrhagic manifestations of C. (skin and subperiostal hemorrhages, a microhematuria) disturbances of a skeletogeny — a so-called rachitic scurvy, or Meller's disease — Barlow are expressed. The baby who got sick with C., it is weakened, pale, the suffering look is noted, the tone of muscles is lowered. Because of muscle and joints pains the child cries when he is swaddled, take on hands, take out from a bed, bathe. Owing to defects of process of ossification near a diaphysis of bones there can be subperiostal hematomas. The movements in extremities become limited and painful. Quite often there is fever. Important symptom of C. at the child scorbutic beads — an inflammation in places of osteoarticular connections of edges are. They remind beads at rickets (see), but are very painful, and pain amplifies at breath because of what breath becomes superficial.
Diagnosis. Early diagnosis of a hypovitaminosis With is complicated due to the lack of specific symptoms. Its existence should be assumed at emergence of muscular weakness, fatigue, periodic bleeding of gums in the persons receiving defective food and also (along with other hypovitaminoses) at starving and at patients with long diarrhea. The diagnosis in these cases can be validated by detection of reduced concentration ascorbic to - you in blood or ex juvantibus.
Initial manifestations of C. (the first degree) are rather specific in the set. The diagnosis is based on detection typical for C. ulitis and characteristic scorbutic purpura. The accounting of data on food and complaints to fatigue and onychalgias during the walking is important. In process of development of C. diagnostic value changes of skin (dark, dry, shelled) get, emergence of hemorrhages of different localization, and also data rentgenol. researches of bones.
Rentgenodiagnos the t and to and is based on identification of the characteristic changes of bone system accruing according to duration and weight of manifestations of C. First of all an epiphysis and metaphyses of tubular bones (is more often than the lower extremities) are surprised, children have edges in places of osteoarticular connections. Early rentgenol. the general osteoporosis (see) can be a symptom of a disease, an anatomic basis to-rogo is reduction of formation of bone substance. It leads to excess accumulation of lime in a zone of preliminary calcification, and in adjacent sites of a metaphysis — to multiple fractures of the thinned bone beams with involvement in process of cortical (compact) substance. On roentgenograms the zone of preliminary calcification is expanded, its thickness in the center of a bone is increased in 2_z time, and towards the surface of a bone it is narrowed and comes to an end with the acute ends which are going beyond cortical substance. The line of an epiphyseal cartilage disappears owing to rapprochement of kernels of ossification of an epiphysis and a metaphysis, to-rye are divided only by a zone of fragments. In kernels of ossification of an epiphysis, deadlines of emergence to-rykh are not skirted, observed osteoporosis of spongy substance and emergence of a dense border the, wide in comparison with norm, limiting an ossification center. Deformation of vertebrae as «fish» in combination with osteoporosis can be observed.
At children, sick C., important rentgenol. emergence obyzvestvlyayushcheysya hematomas is a sign. Subperiostal hemorrhages come to light radiological in the form of narrow strips of the periosteal calciphied imposings which are symmetrized usually around a bone. In case of repeated hemorrhages of a knaruzha from earlier formed strips new linear shadows of calcification form, the hematoma occupies the site of a bone from a metaepiphyseal zone to an upper or average third of a diaphysis.
The differential diagnosis is carried out generally with hemorrhagic diathesis (see) various etiology. It is necessary to consider that skin hemorrhages at C. are localized preferential around hair follicles and arise in the absence of changes in coagulant system of blood and dysfunctions of thrombocytes. In rare instances carrying out differential diagnosis requires a research of concentration ascorbic to - you in blood, considerable decrease a cut is specific to
Ts. U of children there is a need to differentiate C. with rickets (see). Unlike rickets of damage of bones at C. are characterized by morbidity and develop at normal concentration in blood of phosphorus and calcium, and also at normal activity alkaline phosphate zy (if C. and rickets do not accompany each other). The first introductions ascorbic to - you to the child, sick C., almost do not change its sharply reduced concentration in blood.
Treatment. Means of specific therapy of C. — ascorbic to - that. It is applied in the daily doses considerably exceeding the need for redoxon at healthy people (48 — 108 mg), and the therapeutic dose shall those be higher, than it is heavier than manifestation of C. Treatment of sick C. the first degree it is carried out on an outpatient basis and limited to use ascorbic to - you (inside and intravenously) in a daily dose of 300 — 500 mg (to children — 100 — 300 mg), but not less than 200 mg, and also a routine (150 — 300 mg a day) against the background of the diet enriched with products with the high content of redoxon (see. And it is fast-binovaya acid). Sick C. the second and third degree hospitalize since on weight of a state they need leaving and use of means of symptomatic therapy, indications to a cut can have urgent character (hemotransfusion or eritrotsitny weight at anemia, a pericardiocentesis at a hemopericardium, etc.). At C. the second degree ascorbic to - that is appointed in a daily dose by not less than 500 mg, and at C. the third degree — not less than 1 g, and apprx. 1/3 daily allowances of quantity in the first days of treatment enter parenterally. Rutinum is also appointed in the raised doses (to 0,5 — 1 g a day). Apply other vitamins, at anemia — folic to - that and iron preparations (under control of its concentration in blood serum). At a heavy ulitis appoint mechanically sparing diet No. 1 enriched with redoxon; the composition of food ingredients is korrigirut depending on existence and character went. - kish. frustration. Apply 3% solution of hydrogen peroxide, strong tea and other infusions and plants decoctions containing catechins (see) to rinsing of an oral cavity, gingivas irrigate with freshly cooked 1% water solution of Galascorbinum, oil solutions of vitamins A and E.
At the complicated current of C. the volume of therapy increases according to character of complications. In all cases of the complicated current of C. ascorbic to - that is appointed in higher doses (to 2 g a day). In the presence of osteopatiya and arthropathies, formation of rigidity of joints during the beginning recovery apply physical therapy and LFK.
Forecast. At uncomplicated C. the first degree in the conditions of normalization of food and performing adequate therapy the forecast for life and health favorable. It worsens at C. the second and third degree, becoming doubtful in case of massive hemorrhages in serous cavities, kidneys and other internals and serious at a hematencephalon. At the persons who transferred C. the second and third degree, formation of muscular contractures, rigidity of joints are observed, went. - kish. frustration accept a chronic current. Significantly the forecast at accession worsens acute inf.
diseases, sepsis, at an exacerbation of tuberculosis.
Prevention. In the USSR thanks to: to implementation of large-scale: actions for primary prevention of a vitamin deficiency (see), including nation-wide actions for providing the population with good nutrition (see Food, Food, the program), almost complete elimination of Ts. V to prevention of C is reached. essential value have a dignity. education concerning a balanced diet, contents in products of vitamins, including ascorbic to - you, early manifestation gipovitamino call; the production of vitamin drugs meeting demand (see); purposeful improvement of technology of processing of foodstuff (see); implementation in life and in network of public catering (see) the recommendations about the balanced food (see) considering the standards of daily need for vitamins approved by M3 of the USSR including in redoxon, depending on age and a floor, a metabolic cost, influence of climatic and other environmental factors.
For the purpose of mass prevention of a hypovitaminosis With at the enterprises of the food industry produce enriched ascorbic to - that milk and refined sugar. In child care facilities, and also in maternity homes and hospitals carry out obligatory S-vitaminiza-tsiyu ready food, adding ascorbic to - that to the first or third courses taking into account the daily need for vitamin of an organism of children, teenagers, men, women, pregnant women and nursing mothers (see Vitaminization of foodstuff). In a diet of the military personnel, in case of insufficient contents in it fresh vegetables and fruit, also add ascorbic to - that at the rate of 50 mg a day on the person. The persons which are affected on production by toxicants, high temperature and nek-ry other harmful factors, ascorbic to - that are given in a complex with other vitamins (quite often in addition to special food allowances) directly at the enterprise under control of workers of MSCh or health centers (see Food treatment-and-prophylactic).
The special attention shall be given to individual prevention of C., especially during the winter and spring periods when the content of redoxon in food stuffs decreases.
It is more preferable that children received redoxon with natural products-vitaminonositelyami if the daily need for it is satisfied with such way. The daily need for redoxon at children of the first year of life makes 30 — 40 mg, aged from 1 up to 6 years — 40 — 50 mg, children of school age have 60 — 75 mg. If the daily need for polyneuramin this period cannot be provided in a due measure with introduction to a diet of enough fresh vegetables and fruit, then it is necessary to use in food tinned vegetables (a sorrel, green peas), compotes, freshly frozen berries (currant, a wild strawberry), decoctions from dry berries of a dogrose, and also to accept ascorbic to - that is on 50 — 100 mg a day. Children of the second half of the year of life shall receive ascorbic to - that with the products and nutritious mixes used for a dokorm. In extreme conditions for prevention of C. infusions and broths from a wild sorrel, needles and cones of coniferous trees, wild berries (e.g., a cranberry, a mountain ash) and other plants containing ascorbic acid (see) can be used.
Bibliography: A nutritional dystrophy in
the blocked Leningrad, under the editorship of M. V. Chernorutsky, page 270, JI., 1947;
The Nutritional dystrophy and avitaminosis, Scientific observations in two years of Patriotic war, under the editorship of I. D. Strashun, page 13, L., 1944; de Castro Zh. Geography of hunger, the lane with English, M., 1954; Men-sh and to about in F. K. Avitaminoz With (a klinikoeksperimentalny sketch), Novosibirsk, 1940, bibliogr., Reynbergs. A. Radiodiagnosis of diseases of bones and joints, book 1, M., 1964; R y with with S. M. Vitamins (Physiological action, exchange, therapy), JI., 1963; The Scurvy at alimentary exhaustion, under the editorship of S. Ya. Kof-man, JI., 1944; Chernorutskiym. B. Observations over a scurvy at the front, Saturday. nauch. works in honor of the 50 anniversary nauch. - the doctor, deyateln. glavn. doctor Obukhovsk.-tsy prof. A. A. Nechayev, t. 1, page 66, Pg., 1922; In a k e of of E. M., S an a r i J. Page and. T about 1-b e r t B. M. Ascorbic acid metabolism in man, Amer. J. clin. Nutr., v. 19, p. 371, 1966; F o m about n S. J. Infant nutrition, Philadelphia, 1974; K i n s m a n R. A. a. H about o d J. Some behavioral effects of ascorbic acid deficiency, Amer. J. clin. Nutr., v. 24, p. 455, 1971. See also bibliogr. to St. Vitamin deficiency.
A. A. Kedrov; V. F. Baklanova (rents.), K. S. Ladodo (ped.), V.P. Tumanov (stalemate.